Lactation

Excretion in breast milk unknown/use caution

Contraindications

Hypersensitivity to albuterol, adrenergic amines, or any component of the formulation

Warnings/Precautions

Optimize anti-inflammatory treatment before initiating maintenance treatment with albuterol. Do not use as a component of chronic therapy without an anti-inflammatory agent. Only the mildest forms of asthma (Step 1 and/or exercise-induced) would not require concurrent use based upon asthma guidelines. Patient must be instructed to seek medical attention in cases where acute symptoms are not relieved or a previous level of response is diminished. The need to increase frequency of use may indicate deterioration of asthma, and treatment must not be delayed.

Do not exceed recommended dose; serious adverse events including fatalities, have been associated with excessive use of inhaled sympathomimetics. Rarely, paradoxical bronchospasm may occur with use of inhaled bronchodilating agents; this should be distinguished from inadequate response. All patients should utilize a spacer device when using a metered-dose inhaler; in addition, face masks should be used in children <4 years of age.

Because of its minimal effect on beta1-receptors and its relatively long duration of action, albuterol is a rational choice in the elderly when an inhaled beta agonist is indicated. Oral use should be avoided in the elderly due to adverse effects. Patient response may vary between inhalers that contain chlorofluorocarbons and those which are chlorofluorocarbon-free.

Adverse Reactions

Incidence of adverse effects is dependent upon age of patient, dose, and route of administration.

Overdosage/Toxicology

Symptoms of overdose include tachycardia, tremor, hypertension, angina, and seizures. Hypokalemia also may occur. Cardiac arrest and death may be associated with abuse of beta-agonist bronchodilators. Treatment includes immediate discontinuation and symptomatic and supportive therapies. Cautious use of beta-adrenergic blocking agents may be considered in severe cases.

Stability

Inhalation solution: AccuNeb™: Store at 2°C to 25°C (36°F to 77°F). Do not use if solution changes color or becomes cloudy. Use within 1 week of opening foil pouch.

Nebulization 0.5% solution: Store at 2°C to 30°C (36°F to 86°F). To prepare a 2.5 mg dose, dilute 0.5 mL of solution to a total of 3 mL with normal saline; also compatible with cromolyn or ipratropium nebulizer solutions

Children >40 kg, patients with more severe asthma, or children 11-12 years: May respond better with a 1.25 mg dose

Bronchospasm (acute): Solution 0.5%: 0.15 mg/kg (minimum dose: 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg (up to 10 mg) every 1-4 hours as needed; may also use 0.5 mg/kg/hour by continuous infusion. Continuous nebulized albuterol at 0.3 mg/kg/hour has been used safely in the treatment of severe status asthmaticus in children; continuous nebulized doses of 3 mg/kg/hour ± 2.2 mg/kg/hour in children whose mean age was 20.7 months resulted in no cardiac toxicity; the optimal dosage for continuous nebulization remains to be determined.

Note: Use of the 0.5% solution should be used for bronchospasm (acute or treatment) in children <15 kg. AccuNeb™ has not been studied for the treatment of acute bronchospasm; use of the 0.5% concentrated solution may be more appropriate.

Children >12 years and Adults:

Bronchospasm (treatment): 2.5 mg, diluted to a total of 3 mL, 3-4 times/day over 5-15 minutes

Test Interactions

Increased renin (S), increased aldosterone (S)

Dietary Considerations

Oral forms should be administered with water 1 hour before or 2 hours after meals.

Patient Education

Use exactly as directed; do not use more often than recommended. Take oral medicine with water 1 hour before or 2 hours after meals. Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. You may experience nervousness, dizziness, or fatigue (use caution when driving or engaging in hazardous activities until response to drug is known); dry mouth, unpleasant taste, stomach upset (frequent, small meals, frequent mouth care, chewing gum, or sucking lozenges may help); or difficulty urinating (always void before treatment). Report unresolved GI upset, dizziness or fatigue, vision changes, chest pain or palpitations, persistent inability to void, nervousness or insomnia, muscle cramping or tremor, or unusual cough. Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.

Pregnancy/breast-feeding precautions:

Self-administered inhalation: Do not freeze. Shake canister before using. Sit when using medication. Close eyes when administering albuterol to avoid spray getting into eyes. Exhale slowly and completely through nose; inhale deeply through mouth while administering aerosol. Hold breath for 5-10 seconds after inhalation. Wait at least 1 full minute between inhalations. Wash mouthpiece between use. If more than one inhalation medication is used, use albuterol first and wait 5 minutes between medications. Prime inhaler prior to first use, and whenever the inhaler has not been used for more than 2 weeks, by releasing 4 test sprays into the air (away from face). Discard inhaler after labeled number of doses are used, even if the canister does not feel empty. Ventolin® HFA: Discard canister after 200 actuations or 3 months after removal from foil pouch, whichever comes first. Store with mouthpiece down. Do not allow metal canister to become wet.

Self-administered nebulizer: Wash hands before and after treatment. Wash and dry nebulizer after each treatment. Twist open the top of one unit dose vial and squeeze contents into nebulizer reservoir. Connect nebulizer reservoir to the mouthpiece or face mask. Connect nebulizer to compressor. Sit in comfortable, upright position. Place mouthpiece in your mouth or put on face mask and turn on compressor. If face mask is used, avoid leakage around the mask to avoid mist getting into eyes which may cause vision problems. Breathe calmly and deeply until no more mist is formed in nebulizer (about 5 minutes). At this point treatment is finished.

Volmax®: Tablets should be swallowed whole; do not crush or chew. Outer coating of tablet is not absorbed and may be found eliminated in stool.

Anesthesia and Critical Care Concerns/Other Considerations

Frequent use of inhaled beta agonists when used in patients with atrial fibrillation, may counteract pharmacologic interventions directed at rate control. Inhaled beta agonists may be used to treat acute hyperkalemia in patients with renal failure.

Wait at least 1 minute between first and second puff of MDI. Because of its minimal effect on beta1 receptors and its relatively long duration of action, albuterol is a rational choice in the elderly when a beta agonist is indicated. All patients should utilize a spacer device when using a metered-dose inhaler.

Cardiovascular Considerations

Beta agonists will induce increases in heart rate. This should be considered in patients with resting tachycardia. Because of the frequent coexistence of chronic obstructive lung disease and coronary artery disease, many patients are on simultaneous therapy with beta agonists and beta-blockade. This combination should, for obvious reasons, be avoided. Frequent use of inhaled beta agonists when used in patients with atrial fibrillation, may counteract pharmacologic interventions directed at rate control. Inhaled beta agonists may be used to treat acute hyperkalemia in patients with renal failure.